The hypercholesterolemias in pregnancy: their etiology and diagnostic significance considerations

Czech version

Authors: J. Hyánek ¹; F. Pehal ¹; L. Dubská ¹; J. Miková ¹; L. Gombíková ¹; S. Kubů ²; P. Haláčková ²; J. Feyereisl ²; L. Táborský ¹
Authors‘ workplace: Metabolická ambulance a Oddělení klinické biochemie, Nemocnice na Homolce, Praha, primář MUDr. L. Táborský ¹; Oddělení klinické biochemie, ÚL Ústavu pro péči o matku a dítě v Podolí, Praha, ředitel doc. MUDr. J. Feyereisl, CSc. ²
Published in: Ceska Gynekol 2017; 82(6): 455-461

Předneseno na 31. sympoziu dědičných metabolických poruch, Bratislava 2016.

Overview

Objective:
Analysis of gestational hypercholesterolemia incidence in Prague population of healthy pregnant women. Diagnostic significance of non-cholesterol sterols as suitable markers of endogenous synthesis and intestinal absorption in etiology of gestational hypercholesterolemia.

Design:
Retrospective study.

Patients and methods:
From 21 000 healthy pregnant women set of 84 patients with blood level of total cholesterol >7.0 mmol/l where noncholesterol sterols had been analyzed by use of GC/MS method on Finnigan MAT 120b. Lathosterol and desmosterol as markers of endogenous syntesis and campesterol and sitosterol as markers for intestinal absorbtion. Classical lipid parameters have been analyzed on Beckman Coulter and Cobas analyzators.

Results:
The median of total cholesterol values in the set of 21 000 healthy pregnant women – 6,8 mmol/l was observed; median of LDLCh – 4.6 mmol/l and HDLCh – 2.2 mmol/l. The frequency of hypercholesterolemia values > 8.0 mmol/l 1:132 (!) was observed. The average values were for lathosterol 7.8 ± 1.7 µmol/l; desmosterol 4.7 ± 0.9 µmol/l; campesterol 9.8 ± 2.6 µmol/l; sitosterol 9.6 ± 3.8 µmol/l. The correlations of lathosterol with total cholesterol r = 0.524 as well as with non-HDLCh r = 0.35 and LDLCh r = 0.36 were observed. In campesterol or sitosterol as well as HDLCh or TAG no significant correlations have been observed.

Discussion:
Pilot study for gestational hypercholesterolemias in Czech population of healthy pregnant women proved the high frequency of increased levels of total cholesterol (> 8.0 mmol/l) 1:132. Increased levels of lathosterol values could explain the hypercholesterolemia in pregnancy as result of higher endogene synthesis of cholesterol.

Conclusion:
Relatively high frequency of hypercholesterolemia in pregnancy is caused according to our findings by increased endogenous synthesis of cholesterol via lathosterol. The highly increased values of cholesterolemia during pregnancy could be efectivelly used for detection and after ending of lactation period for further differential diagnostic and treatment of previously undiagnosed familial hypercholesterolemias.

Keywords:
hypercholesterolemia in pregnancy, non-cholesterol sterols, lathosterol, desmosterol, campesterol, sitosterol

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